Does the student have any special learning needs? If yes, please describe. If no, please put N/A
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Does the student have any allergies, chronic illness, or medical conditions, prescribed medications? If yes, please describe. If no, please put N/A
*

Sibling(s)

Name of Sibling

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.